Tips for Coping with Work When You Have a Sleep Disorder

By Nancy Ancowitz, Salary.com contributing writer.

Society stigmatizes people who are different -- not just the well-recognized differences like skin color, religious beliefs, and sexual orientation. The stigmas are also against people of a quieter nature, heavy people (especially women!), short people (especially men!), and older people. Now a different group is emerging from the shadows: night owls.

You might think it’s nobody’s business when you go to bed. However, if you’re trying to hold down -- or look for -- a 9-to-5 job and you can’t get to sleep each night until the wee hours, you're probably facing chronic exhaustion, which can affect your health and well-being, and ultimately your performance on the job.

What if there were more to being a night owl than you realized? That it wasn’t necessarily a matter of being undisciplined about your sleeping habits, but a biological need?

A colleague who often e-mails me at 4 a.m. recently shared her struggles with delayed sleep phase syndrome (DSPS), a type of circadian rhythm sleep disorder. So I hope sharing more about delayed sleep will be helpful to you -- especially if you or someone close to you is typically wide awake well after midnight, but not because of insomnia.

Peter Mansbach, president of the Circadian Sleep Disorders Network, will share more about the ins and outs of delayed sleep. His organization is an online network of volunteers that provides emotional support and research-based information to improve the lives of people with chronic circadian rhythm disorders, and promotes awareness of these disorders in the medical community and the public. In upcoming stories, you’ll also meet a freelance writer, a software engineer, a draftsperson, and an ethnographer with delayed sleep to learn how they navigate their careers despite their unusual sleep needs.

"People have an internal clock that regulates when they sleep, when they are alert, when they best digest their food, even when they fight disease," says Mansbach, a physicist and software engineer. "For most people, this clock is synchronized with day and night: alert in the day, asleep at night. For some people, however, it is not synchronized with day and night."

I find the clock image useful.

Circadian Sleep Disorders Network’s website sheds additional light: "Circadian means 'roughly daily.' The word was coined some 50 years ago from the Latin terms circa, about, and diem, day. Circadian rhythms cycle daily according to the 24-hour rotation of the earth, and they are internally produced in all living things."

Based on the statistics on the site, half a million people in the United States -- as many women as men -- are affected by lifelong delayed sleep, and it is thought to be responsible for 7 to 10 percent of cases of chronic insomnia.

"In delayed sleep phase syndrome (DSPS) the body's clock runs several hours late," says Mansbach. "The person cannot fall asleep until very late (typically 2 a.m. to 6 a.m.), and needs to sleep correspondingly late in the morning." That sounds like an extreme night owl.

"Advanced sleep phase disorder is the opposite: the body's clock is early," says Mansbach. "A person falls asleep early in the evening, and awakens very early, often at 3 or 4 a.m.," he adds. Now that sounds like a true lark.

He continues, "In non-24-hour sleep-wake disorder, the body's clock runs longer than 24 hours. The person falls asleep later and later every day, and her sleep time progresses around the clock. There are other circadian rhythm sleep disorders: irregular sleep-wake disorder, and extreme forms of jet lag and shift work disorders."

"Most night owls are able to adjust their schedules to sleep earlier when required, so they can get up when needed," says Mansbach. So folks with delayed sleep are night owls who can’t override their body clocks.

"People with delayed sleep phase syndrome are actually unable to fall asleep earlier, and therefore must extend sleep later in the day or become sleep deprived," adds Mansbach.

So it sounds like people with delayed sleep are night owls not out of choice, but because they have special biological needs.

Are you wondering whether you or someone you know has delayed sleep?

Mansbach explains the primary indication is not being able to fall asleep at the appropriate time, night after night, even when sleep deprived—but falling asleep easily and sleeping well later in the night. "Anyone can have difficulty getting up in the morning after staying up late the night before. But most people in this situation can then fall asleep on time the following night. People with delayed sleep phase syndrome generally cannot."

So people with delayed sleep would normalize their sleep habits if they could—but they really just can’t.

"Many people initially cope with delayed sleep by forcing themselves to keep a normal schedule," says Mansbach. "This results in a chronic sleep deficit, with symptoms that can mimic depression, attention deficit hyperactivity disorder (ADHD), chronic fatigue syndrome, fibromyalgia, or primary insomnia." Mansbach advises those affected to see a sleep specialist certified by the American Board of Sleep Medicine.

So how do you know if you actually have delayed sleep, and aren’t just a garden-variety night owl?

"Most commonly, a sleep specialist will monitor the patient's sleep times with an actigraph, a motion sensor worn like a wristwatch," says Mansbach. "It is possible to infer the body's circadian rhythm by measuring core body temperature and/or melatonin levels periodically around the clock, but this is invasive and expensive. None of these is foolproof. Simpler tests are being developed. Often other tests are done to rule out other causes of the reported sleep problem."

Wondering what treatments are available for people with delayed sleep phase syndrome? Mansbach says, "Most commonly, delayed sleep is treated using bright light in the morning and/or melatonin in the evening. Avoidance of bright light in the evening is also advised. Timing of the treatments is critical and must be based on your body's internal clock."

Any other treatment options? "Chronotherapy—going to bed later and later until arriving at the desired schedule—is sometimes recommended, but there may be serious risks, it is a strenuous process, and maintaining the desired schedule may still be difficult," says Mansbach.

“In cases where treatment is ineffective, delayed sleep phase syndrome is recognized as a disability by many researchers and sleep specialists,” says Mansbach. “With documentation from the doctor, students can obtain accommodations from their schools, and workers should apply for accommodations in the workplace. The form of these accommodations must generally be negotiated.”

Misperceptions about people with delayed sleep abound.

"People for whom sleep is not a problem have a very difficult time understanding why delayed sleep is such a problem," says Mansbach. "They ask, 'Why not simply get up earlier and go to bed earlier?' They believe, based on all their own life experiences, that if one gets up earlier and gets tired enough, one will fall asleep earlier as well. But delayed sleep people cannot fall asleep until very late, even when tired."

"Those who do not understand this conclude that delayed sleep people are simply undisciplined or lazy," adds Mansbach. "Some think the disorder is imaginary, or that we don't try hard enough to get on schedule."

Mansbach makes an important distinction between delayed sleep and insomnia. “Allowed to sleep on their body's preferred timing, delayed sleep people have no problem sleeping,” he says. “It is only when they go to bed before their body is ready to sleep that they cannot fall asleep. Primary insomnia is difficulty sleeping at any time.”

The worst advice anyone can give to people with delayed sleep, according to Mansbach, is, “Just force yourself to get up at the desired time every day—your body will adjust."

"For those with delayed sleep phase syndrome who have to get up in the morning, but can't fall asleep in the evening, their sleep debt keeps building and threatens their health," says Mansbach. "Chronic sleep deprivation increases the risk of many serious diseases, including cancer and diabetes, as well as depression, fibromyalgia, and others. It degrades productivity and learning, and increases the chance of accidents. It's really important to get enough sleep on a regular basis."

Stay tuned for the next part of this series on night owls with delayed sleep phase syndrome. You’ll meet a night owl who flew the 9-to-5 coop to go solo as a freelance writer.

Even if you have trouble sleeping, you can't nap on salary negotiations when it comes to job offers and raises. So let Salary.com help wake you up.

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